What the Ebola outbreak tell us about poor governance and state fragility

The Ebola outbreak, which is ravaging West Africa, causing over 4,000 deaths, and has crossed the Atlantic infecting its first case in the United States and now Spain, is an immense tragedy. But it also serves as a reminder of the fundamental challenges of development in a weak institutional environment.

The different patterns of contagion and response between the three most-affected countries (Liberia, Sierra Leone and Guinea) and the less-affected countries (Nigeria, Senegal, and, most recently, USA and Spain) are a testimony to profound differences which go beyond health considerations. While in the first group of countries, contagion has rapidly spiraled out of control, leading to a collapse of the health systems exacerbated by the mistrust of the population over the various warnings provided by the authorities, Nigeria and Senegal’s ability to break the chain of Ebola was quite remarkable. Nigerian health authorities detected the first Ebola case in their country only three days after that person’s arrival in Nigeria from Liberia by airplane, and acted quickly to isolate infectious individuals and trace their potential contacts. Nigeria has observed 20 cases in which Ebola was transmitted, with no new cases reported as of September 8. Similarly, Senegal was able to detect and cured successfully its only case. Both have been declared “Ebola-free”, after six weeks with no new cases. Certainly, one may argue that such countries have been on alert, but there is a big contrast with Liberia, where many citizens even thought of Ebola as an invention by the authorities to get more resources from donors.

A 2005 MIT study on natural disasters, using a dataset of deaths from natural disasters in over 70 countries and through 20 years, found that democracies and nations with higher-quality institutions suffer fewer casualties from natural disasters. This corresponds with the current Ebola epidemic. The world is observing that the gravity of the epidemic and its spread is very closely associated with the weakness of the health sector, as shown in the chart, which shows a clear correlation between number of cases and the limited number of health professionals.

The epidemic has also hit the hardest and has been exacerbated by the state of fragility of such countries, namely in terms of the mix of capacity constraints, lack of trust, weak institutions and poor governance, which all contributed to the uncontrolled spread of the disease. A case in point has been the attacks perpetuated by local communities on health facilities and on the very doctors engaged in outreach and containment. The profound meaning of such attacks is worth exploring.

There is an significant correlation between the gravity of the spreading of the disease and the deeply rooted weakness of the states, as evidenced by the fact that Liberia, the most affected country of the three as reported by a recent post on this blog, is arguably the country lagging behind in terms of nation-building, experiencing deep often historical divisions and still grappling with fundamental questions of identity. All the three countries perform quite poorly on most governance ranking indicators, including the most recent survey by Afrobarometer, which points out that over 78% of Liberians perceive corruption among public officials in their latest survey. Ebola is therefore having an uneven impact on countries, hitting harder where institutions and governance are the weakest.

As major efforts are deployed to contain the health emergency, the next major challenge would be to continue the long process of building stronger institutions and re-establish trust between government and citizens. Such trust could come as a result of efficient and effective management of Ebola aid funds, and by putting in place new mechanisms and developing capacity to improve governance and accountability. With the support of the international community and by demonstrating real leadership and displaying integrity, authorities in the three countries concerned could rapidly regain public confidence. The fight against Ebola and the countries’ respective reconstruction processes are an opportunity to build new foundations based on solidarity and good governance. This includes supporting stronger anti-corruption institutions, including Auditors General, with robust legal mandates that are properly enforced and sufficiently funded; as well as enabling citizens to have a greater say in service deliveries whether in public administration, in schools or in hospitals and clinics.